Patient reported outcome measures concerning urinary incontinence after robot assisted radical prostatectomy: development and validation of an online prediction model using clinical parameters, lower urinary tract symptoms and surgical experience

Abstract

The prediction of post-prostatectomy incontinence (PPI) after robot-assisted radical prostatectomy (RARP) depends on multiple clinical, anatomical and surgical factors. There are only few risk formulas, tables or nomograms predicting PPI that may assist clinicians and their patients in adequate risk counseling on postoperative side-effects. Prospective data collection of 1814 patients who underwent RARP between 2009 and 2017 was done. Pre-operative parameters were age, body mass index (BMI), prostate volume, the American Society of Anesthesiologists (ASA) score, severity of Lower Urinary Tract Symptoms (LUTS), type of planned nerve-sparing surgery and surgical experience. The continence status was reported using Patient Reported Outcome Measurements (PROMs) using the validated pad-use questionnaire EPIC26. Continence was defined as either the use of zero pads or one safety pad. Multivariable logistic regression analysis was performed to identify predictors of PPI within one year after RARP. An online prediction tool was developed and validated. The median follow-up was 36 months (range 12–108). The response rate was high at 85.2%. A total of 85% (1537/1814) of patients was continent on follow-up. One-year continence rate was 80.1% (95% CI 78.3–81.9%) (1453/1814) and increased to 87.4% (95% CI 85.4–89.4%) after 5 years. On multivariable analysis, severity of LUTS (OR = 0.56 p = 0.004), higher age (OR = 0.73 p = 0.049), extend of nerve-sparing surgery (OR = 0.60 p = 0.001) and surgeon experience (OR = 1.48 p = 0.025) were significant independent predictors for PPI. The online prediction model performed well in predicting continence status with poor discrimination and good calibration. An intuitive online tool was developed to predict PPI after RARP that may assist clinicians and their patients in counseling of treatment.

Prediction of Incontinence after Robot-Assisted Radical Prostatectomy: Development and Validation of a 24-Month Incontinence Nomogram

“…To our knowledge, only four post-prostatectomy continence recovery nomograms have been published [ 15 , 17 , 30 , 31 ]. However, all four of the nomograms have variables that may not be known preoperatively to the urologist or to the patient that involve surgical technique [ 17 , 30 , 31 ], imaging to measure urethral length [ 15 ], prostate volume [ 17 ], or surgeon volume [ 17 ]. These nomograms may be less patient-specific, more technique-dependent, and less generalizable.…”

“…Collette et al [ 17 ] described a model predicting urinary continence at one year after RARP that used age, BMI, IPSS, degree of nerve sparing, prostate volume, ASA score, and surgical caseload as predictors. Matsushita et al [ 15 ] incorporated urethral length, in addition to age, BMI, and ASA score.…”

“…The most widely reported risk factors that predict continence recovery after RARP include age [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ], body mass index (BMI) [ 6 , 15 , 17 , 18 ], severity of lower urinary tract symptoms (LUTS) [ 6 , 9 , 17 ], preoperative comorbidities [ 8 , 16 ], preoperative erectile function [ 6 , 9 ], prostate volume [ 19 ], urethral length [ 20 , 21 ], and surgeon experience [ 22 , 23 ]. We hypothesized that the more adverse risk factors for incontinence the patient has before RARP, the more likely he will remain incontinent at 2 years.…”

Robots in Cancer Surgery: A Boon or Bane

“…There are many surgical approaches to implement RARP [83], however not enough evidence to support that these procedures are oncologically safe. The commonly used approaches are Retzius-sparing RARP which has been efficient in earlier recovery from urinary incontinence, a side effect of the surgical treatment of prostate cancer [83] [84]. Nevertheless, RARP is opted by 86% of prostate cancer patients in the United States [13].…”

Evaluation of the effect of levator ani muscle contraction on post‐prostatectomy urinary incontinence using cine MRI

“…It is said that 1%–40% of patients may experience persistent urinary incontinence, 1 and 25% of PPI patients undergo surgery to improve continence 2 . Although the introduction of RARP has contributed to improvement in PPI, a recent report indicated that the 1‐ and 3‐year continent rates remained 80% and 85% 3 . Despite progress in our anatomical knowledge and surgical equipment, it cannot be said that the rate of PPI has improved significantly.…”